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NPI Code Detail

MEDICARE: KAYLA SULLIVAN

MEDICARE: KAYLA SULLIVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner11043953FL

General Provider Information

NPI Number : 1598627341
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLA SULLIVAN
Provider Business Mailing Address
First Line : 115 E GRANADA BLVD STE 1
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32176-6634
Country : US
Telephone Number : 386-265-1441
Fax Number : 386-265-4066
Provider Business Practice Location Address
First Line : 115 E GRANADA BLVD STE 1
Second Line :
City : ORMOND BEACH
State : FL
Zip : 32176-6634
Country : US
Telephone Number : 386-265-1441
Fax Number : 386-265-4066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 05/27/2026

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Directions to “ KAYLA SULLIVAN ” Practice Location

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